Embracing the digital health transformation to build a high-performing operations team (part one)

Healthcare organizations are solving complex challenges, but even a well-oiled machine falls short without embracing digital health transformation.

Growth is one of the most defining and sought-after traits of any organization operating in today's healthcare landscape. Despite the unpredictable leaps and bounds in today's climate, growth is achievable. Focusing on digital innovation and transformation offers organizations a way forward to improve internal operations, increase productivity, and foster patient and provider connections. 

During the annual Medallion Elevate conference, we sat down with two leaders to dive into why now is the time to embrace digital technologies. Riley End is the Chief Operating Officer at Spring Health, which helps individuals and organizations thrive by eliminating barriers to mental healthcare. 

Karan Singh is the Co-founder of Ginger, an on-demand mental health company that combines data science and virtual delivery to provide immediate, personal support. He is also the Chief Operating Officer at Headspace Health, the world's most accessible and comprehensive digital mental health and wellbeing platform.

The conversation is below, and given the breadth of information shared and uncovered, we've split it into two parts. If you're short on time, here are a few quick takeaways: 

  • Change is difficult, particularly in healthcare, but fundamentally, for organizations seeking growth, change and longevity, it comes down to incentives. When leaders encourage their people to take calculated risks to deliver more value internally and to patients, the doors open for new modalities and new ways to transform care.
  • Creating scalable systems comes down to focusing on cultural efficiencies alongside operational excellence to create sustained enthusiasm, which addresses or combats provider burnout.
  • Investing in the right technology, not just any technology, can drive down organizational costs over time which helps scale a business and increases access to drive more impact on the large global issues that exist, particularly in mental health.

If you enjoy this material, check out more sessions from the Medallion Elevate event. A lightly edited transcript of the session with Riley and Karan follows. The conversation has been transcribed and edited to the best of our abilities and please allow for a slight margin of human and machine error. Any questions or concerns, send an email to events@medallion.co for help.

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Derek Lo: Welcome, Karan. Riley, thanks so much for joining us. I'm excited to kick this session off with you both. Before we start, can each of you introduce yourself, your role, and why you do what you do? Maybe, Riley, we can start with you.

Riley End: First of all, thank you for having me today. Very excited to be here. My name is Riley, and I'm the Chief Operating Officer at Spring Health. We're a comprehensive mental health benefit for employers, and I've been with the organization for about four years. At Spring Health, I oversee our health plan operations team, care navigation team, support team, provider operations, coaching operations, and business operations.

Karan Singh: Derek, Riley, good to connect with you both. Thanks for having me as well. My name is Karan Singh, co-founder at Ginger and Chief Operating Officer at Headspace Health since our merger with the Headspace team last year. Like Riley, it sounds like there is lots of good overlap here about supply-side innovation and figuring out how to deliver an incredible experience for members and scale our system that provides a lot of the infrastructure to meet a massive amount of needs. 

I've been on this journey for over a decade now after a loved one tried to take their own life; it set me on this course. There was a pre-COVID story, and there's a COVID story regarding access to mental health care, something that almost everyone nowadays is experiencing in some form or another. So, it's great to be here and in a conversation about operations and digital health. That was not a thing a while ago. Now it is 200 to 800 people strong.

Riley End: Yeah, we made it.

Karan Singh: That's right. It's a good way to put it.

Getting buy-in at the individual level leads to change

Derek Lo: Thank you both for spending time with us today to kick this off. Change is hard, especially in healthcare. Why do you think it's taking so long? And what do you think are some of the underlying reasons? So maybe Karan could start with you.

Karan Singh: Fundamentally, it comes down to incentives. The system is designed to achieve a specific set of outcomes. Historically, it's been around a fee for service medicine, which has meant it's all about the number of transactions, the volume, not the value or the quality of what you deliver. Historically, that means you don't focus on prevention and kind of nontraditional courses of treatment. So you're largely in a kind of medicalized model. And as a result, any innovation can be seen as a threat. I think it's balanced out with some level of hype and overpromising and under-delivering on a lot of this innovation. But I think a lot of this is because you needed a massive sort of exogenous shock to the system like Covid to get people to try something new and then realize, hey, it works incredibly well and can support a big portion of the need. The other probably obstacle in many ways can be member safety and privacy, if you will, as a crutch to what's possible. It has to be at the center. The member or the patient is at the center of what we all do.

But often, I think there's a misunderstanding of what we can do in a way that's still safe for the member. So change can be perceived as probably in conflict with keeping the member first when it doesn't have to be. Again, it comes down to incentives and how you're encouraging people to take calculated risks to deliver more value.

Riley End: Yeah, I'm happy to add on, and my guess is we probably have similar answers to a lot of these questions. Totally with you, Karan. I think the first short answer is deeply entrenched stakeholders with misaligned incentives. And that's what you spoke very succinctly about there. I think the other is a societal and individual level exception and acceptance and adoption, particularly with mental health, right? With many of our clients, we spend a lot of time on awareness and culture because before you even get engagement and you can refine based on data, you need people to be okay with using it. Certainly, there's an element of privacy as well involved, but I think what we've seen through Covid is a rapid acceleration in the destigmatization of mental health, which is a net positive for society. Then you pile on the individual willingness to adopt things like teletherapy. Covid rapidly accelerated that as well. There's so much change at once, and then you have the misaligned incentives of stakeholders, society, and individuals; it's a lot to navigate and prioritize candidly.

The collective excitement around innovation

Derek Lo: Besides the increasing adoption of telehealth, what do you think has changed the most in the past two years as it relates to just general digital transformation in healthcare? Riley, you can take this one.

Riley End: Our answer is data. Suppose you have a homegrown system or are building infrastructure on what historically was probably disparate data systems. In that case, there are now ways to get near-time, if not real-time data on hundreds of different data points. It creates a net new problem of what you listen to, when, why, and what you do with it. So I think for us, we're a very KPI-driven organization, but with the adoption of telehealth has come the proliferation of data. And I think, most importantly, members are benefiting from that. Our first value at Spring Health is members come first. So how do we use data near time to iterate on precision mental health care so that we're surfacing the right care plan at the right time and essentially removing waste from the behavioral health system? Data is the biggest change.

Karan Singh: Yes. We very much share that approach and mentality. I think it's a huge opportunity. I'd push that even further, maybe just in a different dimension, which is to say, I think it's more than just putting an offline visit online. And that's largely what a lot of the telehealth kind of initiatives have been focused on. It's about fundamentally reimagining the care delivery system, right? And thinking about, well, what happens if you can actually deliver care outside of a 50 minutes therapy visit in the case of mental health? But this is true in primary care and so much rest, especially medicine, where you can start to unlock new types, new forms of support, mindfulness coaching, all the way down to nurse practitioners, delivering medication management. I think one of the things that I've been most excited about going back to question one, is the incentives are starting to change with payment model reform and payment model innovation. As you start to pay for these new kinds of treatment modalities, you begin to unlock access and start to unlock different kinds of different paradigms of care.

I'm particularly excited about destigmatization and a willingness for people to start to engage and get access to a tele-model and start to find treatment or support in nontraditional ways that can work incredibly well. 

To the last part, there's now an ecosystem of vendors, of providers of other folks who, in the past, we have had to build ourselves. Now we might even have an opportunity to partner to help create that new care delivery model. And that just wasn't true before. Now some specialized vendors can help us build those systems that we need to scale. So I think it's unlocked a lot of innovation, a lot of excitement, and we have a long way to go. There's still a whole lot of work to be done.

Derek Lo: Following on to something you just said about the reimagination of virtual care. It's fascinating that Ginger merged with Headspace. I'm curious, are there things you can share about how you're merging the two to build a new care experience for patients? 

Karan: Yeah, I might sort of take it a level up even beyond mental health specifically and just kind of talk maybe more broadly. I know this isn't a mental health-focused panel per se, but it's a system of care. It starts with growth and personal transformation from prevention to actual licensed clinical care. And most of the system is focused on the last bucket when the reality is we're not going to solve this supply and demand crisis without also focusing on or adding to that upstream support. That's where mindfulness, meditation, and behavioral coaching resources are a critical part of that equation. But they are also insufficient because you have increasingly far more than before Covid, many members who really need an acute level of treatment. And like Riley, I also think you need to deliver evidence-based support to those members and get them the level of care they need. And so, for me, it's just like thinking about this digital transformation as an opportunity to rethink the traditional fee for service and think about the other ways you can begin to deliver value and get paid for that value that you're creating.

Ultimately it's better for members because they're getting support far upstream and great for the system. After all, writ large, it should save costs.

Operational excellence begins with your mindset

Derek Lo: Shifting gears a little bit. How do you define operational excellence, and how do you achieve it?

Karan Singh: The truth is this is hard. I've found that there's clearly no magic bullet, but I think it starts with a mindset in many ways. It's an approach like it's a muscle that you build, where you create all levels of the organization that thinks about people, process, and product and how you can combine various approaches to create value and scale. I think a lot about essentialism, the concept of less but better, and how you do it, especially in a world where so many of us are overwhelmed. Ryan and I both provide support to members who need mental health care. But the reality is, internally within our teams, I'm sure there's just an incredible amount of stress and change that's come through Covid. So we think a lot about how you make it effortless. How do you create highly scalable systems, no matter how much load you put on the system? That's operational excellence measured through a set of metrics and KPIs, and other data points that allow you to achieve value for providers and members. But it's equally about how you do that internally without creating a bunch of swirls on your teams to get stuff done. That's part of the buzz. Curious Riley, from your perspective, we certainly saw a lot of changes as we shifted to virtual experience early on in Covid, but maintaining operational excellence through this period has been tap dance.

Riley End: Yes, I completely agree. We could have a whole conference on this with several panels on it. Throughout my career, I've been very focused on managing operational and cultural efficiencies as businesses scale. And early on, I thought operational efficiencies, gross margin, those things were up here, and cultural efficiencies were down here. What I've realized throughout my career is actually the inverse. If you have to pick one, it's cultural efficiency. And we try to refer to the inverse of burnout and call it sustained enthusiasm. How do you focus on sustained enthusiasm for your team members? And how can we be a place to give credit where credit is due? Like at One Medical, we have some team members that spent seven years to a decade at One Medical. Why does someone want to stay there for that long? So you have the career growth and sustained enthusiasm that is directly related to operational excellence. We have a team at Spring Health called Operational Excellence, and it's part of our business operations team. The challenge is trying to orient our Operations teams on five different factors we care about: clinical outcomes, member satisfaction, provider satisfaction, unit economics, and last but not least, employee engagement. So [identifying] how we impact those or which ones should we do now and over what period and [measuring] what success looks like [is something we're focused on]. Because of the proliferation of data, we have the ability to do a unit economics analysis and look at every single workflow that every team does and the cost per minute of that workflow and put weighted factors on how it is influencing clinical outcomes, provider satisfaction, and member satisfaction. 

So if the goal is to improve clinical outcomes, will the initiative be cost positive, cost-negative, or neutral? I've been here four years; we are just now getting to the point where we have a team focused on cranking the engine and tightening the screws on the engine, is what I always say.

You have to do this in a way that increases member satisfaction and clinical outcomes. It can't be a detriment to those things, or we're not going to move the needle. 

Karan: I love that. I think it's spot on and again, we're talking about mental health, but it's true for so many of the companies in digital health that have that same tension and are trying to optimize for a variety of these different variables at the same time. It's tough to do, but when you can set up the right infrastructure and focus on the people in addition to the process, products, or data you need, I feel like that's the combination.

Using people plus content to guides decisions

Derek Lo: I like what you both said about flipping provider burnout to sustained engagement; it is interesting to think about it reversely. Let's transition to how you run your teams. How do you think about problem-solving with people versus what to solve with technology? 

Riley End: I'll give the mental health version. We believe deeply in precision mental health care at Spring Health. And Karan, what you said earlier, to resonate around so much focus is on the point of care. But there is so much work to do before the point of care. As companies scale, at startups scale, the initial approach is to throw people at the problems, right? What I'm now saying to our team is if we were to build Spring Health today instead of piecemeal how we made it, we should assume that we could build it 30% more efficiently than we have today. It's about how we can become more efficient. We believe, even with data, that humans are so complex, and mental health is so complex that we don't think humans can or should be entirely removed from every situation. We still expect humans to have a very important role in providing mental health services. What we care about, though, is access, broadening access to mental health care.

As you think about scale, employing people does cost money, and there are more efficient ways to do it. And it's about finding the appropriate balance of people and technology at every stage of growth. It's the Tesla business model, right? We will have more data as we get more people in the system. We can invest in the right technology, not any technology, and therefore we can drive down cost over time. If you drive down costs, more people can access it. You remove waste from the system. So we think about getting to scale, becoming more efficient, while at scale, decreasing cost, so that you can increase access to drive more impact on the large global issues that we have in mental health.

Karan Singh: All the above. In addition, we think that new models of treatment or support, like meditation, mindfulness, and kind of guided content, are a critical part of that equation. So it's both people plus content if you will. 

I took your question slightly differently, Derek, which was, what does it look like internally, and what do you think about buy versus build decisions? As you said, Riley, the default was just people in the early days because you didn't know. You needed something flexible. You hired a team that focused on a thing or developed a band-aid version.

Now that we've learned [what's needed] over the years, something that guides our decisions is [identifying whether] this is a core differentiation. [We ask] Do we feel this is fundamental to our competitive differentiation? If it's eventually going to be a commodity, maybe it's something we can buy off the shelf to support that specific workflow or process. [We assess] if this is a test scenario and if it's just building a bridge until this other process or product kind of kicks in. Or [we assess] is this a scalable investment we need to have ready for prime time for millions of members because we're going live with a big employer, large health plan, or partner. 

Finally, it comes down to resourcing. We've got to think about places we can potentially buy, and it's tough, to be frank. I think one of the things we've seen is sometimes we made the buy decision, which was a very poor decision because we were oversold. We thought someone was going to deliver on a whole bunch of stuff, and it turned out it just meant we needed even more people, and it cost us more because now we've got this third-party tool. 

You learn those things, and you make your way through that. But it keeps coming back to whether this is fundamental to your differentiation. Is this something you want to continue to get excellent at, or do you think someone else could do that and get scaled by doing that for multiple people?

Derek: Yes, it makes a lot of sense. Have you found that there's been resistance in cases where you have adopted new technology or even outsourced parts of your operational staff? 

Karan: Short answer, yes. A large part has to do with the change management and rollout process. I don't think it's unique to internal or external products. But there needs to be that buy-in upfront. You need to identify those early adopters, the internal advocates. You need to have enough time for the change management to set in, build trust, and actually let things rise. You can't force the issue. 

It's more like can you tee this up for success? 

At the end of the day, if you're solving a real business challenge and people see that and see the value that this new system or tool process will provide, then it's a matter of getting enough people to see that for themselves and then allowing them to really advocate and get the organization there. 

So we've seen both. We've botched it at times when we rolled it out and didn't necessarily run that process effectively. We've seen it go incredibly well even for complicated, complex systems that might touch every team and when we're ripping it out and moving to a new workflow, process, or product. 

Riley: I agree with that. I'd add that it depends on the scale you're at, too. I think early on in building operations and services and marketplace models. You do have to make quick decisions. Karan, it helps me to hear that you've made some wrong decisions and brought in solutions to solve problems, but they created more work. But you do have to make decisions with 50% of the insights. You want to make those decisions and be open and transparent with the stakeholders that will be impacted and say that this is an experiment. This is what it is trying to achieve, and you have to move fast and learn, and when you get to the scale that our companies are at, the stakes of doing it with that approach are way too high. So we've matured a great deal, and we start with listening. I learned at my last company, an online education company that teaches people how to be software engineers and developers, that it's a good thing to be transparent about the business model and the why behind it.

In our case, it is impact and access, and we need a sustainable business model. Starting up top in the why and taking the time to listen and not rush it and not force it on people is important, especially as you get into the growth, more mature stages of a company, right? 

Karan: I like that. There's a different answer I'd have had in the early days compared to where we are today or where we're going.

So much of this is about matching complexity to the stage; like Riley, speed matters. Because speed can mean you can learn much faster. And speed matters because if you move too fast and don't plan enough with the right people like you just described, it can cause a lot more swirl than you want. 

If you're a 510-person team versus a 500-person team versus a 5000-person team, some of these processes need to be far more sophisticated, and they have a little more time to bake to make them happen. That's the balancing act.

Part two of this conversation is available here.

About Medallion Elevate: The Future of Healthcare Operations

At Medallion's inaugural debut, Elevate: The Future of Healthcare Operations, healthcare executives, founders, and leaders came together and highlighted the collective optimism of an industry that's ready to elevate and advance the industry. 

It represented actionable insights, disruptive ideas, and ground-breaking insights from some of the best healthcare leaders, visionaries, investors, and founders. For more information and to view the sessions on-demand, visit: https://elevate.medallion.co/events/medallion-elevate-2022/registration   

Today and every day, we celebrate the critical endeavors of these health leaders and changemakers. #MedallionElevate

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